Cairns J A
Can J Cardiol. 1993 Jul-Aug;9(6):490-7.
There is unequivocal evidence for the reduction of early mortality (up to about 35 days) by SK, APSAC and rt-PA, each compared with placebo, for patients treated intravenously within the first few hours of onset of acute MI. An overview of early trials demonstrating mortality reduction with SK, has been confirmed by three level I trials of SK, one level I trial of APSAC and one level I trial of rt-PA. The early benefits observed in the large trials of SK, APSAC and rt-PA have persisted at the one-year follow-up. The initial two large trials which directly compared mortalities of therapy with SK, rt-PA and APSAC detected no significant differences. However, the recently presented GUSTO trial has demonstrated greater mortality reduction with accelerated rt-PA plus heparin, compared with regimens of combined rt-PA/SK plus heparin, SK plus iv heparin, and SK plus sc heparin.
有明确证据表明，对于在急性心肌梗死发病后头几个小时内接受静脉治疗的患者，链激酶（SK）、茴香酰化纤溶酶原链激酶激活剂复合物（APSAC）和重组组织型纤溶酶原激活剂（rt-PA）与安慰剂相比，均可降低早期死亡率（最长约35天）。一项关于早期试验的综述表明，SK可降低死亡率，这已被三项SK的I级试验、一项APSAC的I级试验和一项rt-PA的I级试验所证实。在SK、APSAC和rt-PA的大型试验中观察到的早期益处持续到了一年的随访期。最初两项直接比较SK、rt-PA和APSAC治疗死亡率的大型试验未发现显著差异。然而，最近公布的全球急性冠脉综合征治疗策略试验（GUSTO）表明，与rt-PA/SK联合肝素、SK加静脉肝素以及SK加皮下肝素方案相比，加速使用rt-PA加肝素可更大程度地降低死亡率。
